Current opinion in pediatrics
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Curr. Opin. Pediatr. · Jun 2008
ReviewALARA: is there a cause for alarm? Reducing radiation risks from computed tomography scanning in children.
Radiation exposure from computed tomography is associated with a small but significant increase in risk for fatal cancer over a child's lifetime. This review aims to heighten awareness and spearhead efforts to reduce unnecessary computed tomography scans in children. ⋯ Advocacy by pediatric healthcare providers to promote intelligent dose reduction based on the principles of ALARA and the judicious use of computed tomography scanning is essential to foster the safest possible care of children.
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Curr. Opin. Pediatr. · Jun 2008
ReviewEmergency department treatment of primary headaches in children and adolescents.
Headaches in children and adolescents are common presenting complaints in emergency departments. There is wide variation among acute treatments. We sought to review options for acute emergency department management and the recent evidence supporting their use. ⋯ Further research is needed on therapies targeted toward children and adolescents with headache subtypes other than migraine, including those without a previous diagnosis. While little evidence exists, most authors agree with an initial trial of ibuprofen followed by sumatriptan nasal spray for children over 12 years of age for those with persistent symptoms. Antiemetics remain an option for those with nausea and/or vomiting as a prominent feature of their illness. Other treatments such as ketorolac are still being investigated in children.
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Sickle cell disease is one of the most prevalent genetic diseases, affecting 1 in 600 African-Americans. The lung is one of the major organs affected in sickle cell disease and the pulmonary complications of sickle cell disease result in significant morbidity and mortality in children. ⋯ The pulmonary complications of sickle cell disease include airway hyperreactivity, acute chest syndrome, chronic sickle lung disease, pulmonary hypertension, and sleep disordered breathing. Further understanding of the interrelationships between these disorders will lead to improved therapies.
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Curr. Opin. Pediatr. · Apr 2008
ReviewEvaluation and management of steroid-unresponsive nephrotic syndrome.
Idiopathic nephrotic syndrome in children is commonly associated with minimal change disease and response to steroid therapy. Steroid-unresponsive nephrotic syndrome is often characterized by persistent proteinuria and progression to chronic kidney disease. Focal segmental glomerulosclerosis is the leading cause of steroid-unresponsive nephrotic syndrome in childhood. There is no uniformed consensus as to the treatment of steroid-unresponsive nephrotic syndrome. Advances in the pathogenesis, genetics and biomarkers or surrogate markers may be useful for the diagnosis and identification of patients with steroid-unresponsive nephrotic syndrome, severity of disease, progression and response to therapy. ⋯ Recent studies in both children and adults have shown an increase in the incidence of focal segmental sclerosis as a cause of steroid-unresponsive nephrotic syndrome. Advances in the pathogenesis and noninvasive methods of diagnosis may allow for the identification of steroid-responsive patients.
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Curr. Opin. Pediatr. · Apr 2008
ReviewContinuous positive airway pressure: scientific and clinical rationale.
To present recent data on the role of noninvasive ventilation in the respiratory management of newborn infants. ⋯ Noninvasive ventilation has partially fulfilled its promise as a gentler alternative to ventilation via an endotracheal tube. Appropriately designed randomized clinical trials are required to determine the best nasal interfaces and pressure generators.